This project will develop a speech-recognition test in noise (SRTn) for use as a screening test for hearing disability, suitable for delivery over the telephone. Successful development and implementation of such a test has the potential to greatly increase awareness of hearing disorders and the numbers of persons with hearing impairment who seek services. The test will be based on the National Hearing Test that has been used for the past four years in the Netherlands. The scientists who developed that test, and who subsequently consulted with UK scientists in developing an English version (also now in use), have agreed to participate in the development of a version of the test with speech materials spoken in a Middle American dialect. The test employs spoken sequences of three single-syllable digits, presented in a background noise with a speech-shaped spectrum. The threshold is determined by an adaptive tracking procedure. This test, administered by home telephone, has been shown to be strongly correlated with average pure-tone thresholds and even more strongly with sentence recognition in noise. The sensitivity and selectivity of the three-digit telephone test as a measure of clinically significant hearing disability were 0.91 and 0.93, respectively, for disability defined by performance on sentence recognition in noise. In the first year of its availability in the Netherlands over 100,000 people elected to take this test. This represented a large increase in the total proportion of hearing-impaired persons who have had a hearing test (historically, only one in five in the US). The US version of the test will be developed, using three-digit sequences recorded by a native speaker of Middle American English. Thresholds will then be determined by telephone, for a set of approximately 50 hearing impaired and 20 normal hearing persons, using an adaptive tracking procedure. Pure-tone thresholds and standardized speech discrimination tests administered to these same listeners will be used to determine whether the high correlations between the telephone test and measures obtained in the clinic, as found in the Netherlands, can also be achieved with a US version of this test. Sensitivity and selectivity values for the test will be determined for the identification of persons with clinically significant pure-tone loss and for those with reduced speech discrimination in noise. An estimated 28 million US citizens have impaired hearing, and approximately half of them are under age 50 (NIDCD, 1996). Successful implementation of such a test in the US could greatly increase both the awareness of hearing disorders and the numbers of persons benefitting from hearing aids and other treatments. PUBLIC HEALTH RELEVANCE: The goal of this project is to develop and validate a telephone-based screening test for impaired hearing, modeled after the highly successful National Hearing Tests currently in use in the Netherlands and the United Kingdom. It is estimated that roughly 80% of the 28 million hearing-impaired persons in the US who could benefit from hearing aids have never had their hearing tested. An inexpensive, reliable, and extremely convenient test is likely to be taken by many people who suspect that they have impaired hearing but have hesitated to visit a hearing professional for testing.